Legally Speaking: School nurses and emergency care

By | 2021-11-04T09:08:20-04:00 September 21st, 2015|3 Comments

As an emergency nurse, you know one of your greatest skills is rapid assessment and treatment, especially during an initial phase of acute illness and/or trauma.1 Although an emergency nurse needs only to be licensed as an RN, many have advanced their educational preparation for this role beyond the diploma or associate degree levels. Obtaining a baccalaureate degree in nursing provides for more employment opportunities, and a master’s degree and/or certificate in emergency nursing through the Emergency Nurses Association provides avenues for such roles as a critical care clinical nurse specialist or an acute care nurse practitioner.2

One area in which the BS degree is important is in school nursing. The National Association of School Nurses recommends the baccalaureate degree in nursing and RN licensure as the minimum qualifications for the school nurse.3 In addition, states that require certification in school nursing and those that suggest this certification require a BSN or a BS in a related health field with additional required course credits in specified areas in order to sit for the certification exam.4

School emergency care

In school nurse emergency care, an aspect of school nursing, a BS degree and additional certification is vitally important. School nurse emergency care is guided by principles of good nursing care for school-age individuals but also is regulated by many state and federal laws. Although experience is extremely helpful when fulfilling the school nurse emergency care role, the knowledge gained by obtaining a BSN “increases the nurse’s professional development, prepares the nurse for a broader scope of practice, and provides the nurse with a better understanding of the cultural, political, social and economic issues that affect patients and influences healthcare delivery.”5

This broadened knowledge base is pivotal for the school nurse generally and when providing emergency care to students. How to work within the regulatory and applicable laws such as the Individuals With Disabilities in Education Act, the Americans With Disabilities Act, the McKinney-Vento Homeless Assistance Act, consent for treatment of students, student individualized emergency plans, documentation and the state nurse practice act and its rules, requires critical thinking, leadership and management skills, which the school nurse can further develop in a baccalaureate program while combining that knowledge with advanced skills and expertise in emergency school nursing.

When such laws are not met by the school nurse, or when the school nurse’s emergency care results in an injury to or death of a student, legal liability can occur. For example, in Schluessler v. Independent School District No. 200 et al.6, a high school student died as a result of an asthma attack at school. The family sued the school and the nurse alleging the school nurse’s negligence caused their daughter’s death by failing to properly assess the severity of the attack and failing to summon emergency care. The jury in the case awarded the parents $142,289.6

The court established the standard of care for school nurses in health related emergencies: “School nurses have a higher duty of care than hospital nurses to make an assessment of the need for emergency services”.6 Because they do not have the benefit of emergency room staff and equipment, school nurses faced with an emergency must be able to quickly and competently recognize impending and actual emergencies, summon appropriate emergency medical services and stabilize affected individuals.7

The school nurse in the Schlussler case also faced a revocation of her license by the state board of nursing, but entered into an agreement with the board that placed her license on conditional status as long as she completed additional education, training, monitoring and reporting to the board.7
Quick and competent school nurse emergency care is essential to the health and well-being of all students. In fact, many states, including Illinois, Pennsylvania, Indiana, Connecticut and New York, offer school nurse emergency care courses through respective state health departments, higher education nursing courses, and certification programs.

If you are a practicing school nurse or your role is that of providing school nurse emergency care and you have not yet obtained your baccalaureate degree, seriously consider doing so. You will be among many of your nurse colleagues — 44.6% according to 2013 figures8 — who have heeded the need for baccalaureate degrees in nursing. The student populations you serve deserve the best nursing care and the best emergency nursing care you can provide.

As a nurse whose practice setting is a school, you will have embraced higher education in your nursing specialty. You will also have invested in your unwavering commitment to meet the current and future challenges of your students’ emergency care.


1.Nurses for a Healthier Tomorrow (n.d.). “Emergency Nurse”. Available at . Accessed 8/12/15.
2. “Emergency Room Nurses: Career and Salary Facts” (2015). Available at . Accessed 8/13/15.
3. “Careers: How to Become A School Nurse.” Available at Accessed 8/13/15
4. National Board for Certification of School Nurses (n.d.). Available at . Accessed 8/13/15.
5. American Association of Colleges of Nursing (2014). “Fact Sheet: The Impact of Education on Nursing Practice. ??
6. Schluessler v. Independent School District 200, et. al, MM89-14V (105196) Dakota District Court (1989).7. Janis Hootman, Nadine Schwab, Mary Gelfman, et. al, “School Nurse Practice: Clinical Performance Issues”, in Legal Issues In School Health Services: A Resource for School Administrators, Attorneys, School Nurses (2005). Nadine Schwab and Mary Gelfman, Editors,168-169.
8. Jennifer Thew (n.d.), “More Nurses Seek BSN Degrees.” Available at .


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About the Author:

Nancy J. Brent, MS, JD, RN
Our legal information columnist Nancy J. Brent, MS, JD, RN, received her Juris Doctor from Loyola University Chicago School of Law and concentrates her solo law practice in health law and legal representation, consultation and education for healthcare professionals, school of nursing faculty and healthcare delivery facilities. Brent has conducted many seminars on legal issues in nursing and healthcare delivery across the country and has published extensively in the area of law and nursing practice. She brings more than 30 years of experience to her role of legal information columnist. Her posts are designed for educational purposes only and are not to be taken as specific legal or other advice. Individuals who need advice on a specific incident or work situation should contact a nurse attorney or attorney in their state. Visit The American Association of Nurse Attorneys website to search its attorney referral database by state.


  1. Avatar
    Carol September 28, 2015 at 5:08 pm - Reply

    Well said. I do not think that most people are aware of the complexity of school nursing today.

  2. Avatar
    Mary Jones September 28, 2015 at 5:18 pm - Reply

    I must tell you how tired I am of reading about the push for Bachelors, Masters, NP, and Doctorate degrees. I graduated from an ADN program from which 15 students were chosen for a preceptor program at a major hospital. There were only a few graduates from the local university programs. I believe I was trained well, and I have worked in every setting that has interested me: Cardiac Care, Cardiac Rehab, teaching, charge nursing, and currently Occupational Health. These articles always imply that an ADN nurse has a deficient knowledge base and less than ideal skills, and an inability to communicate well. I believe registered nurses should be assessed on their skills and abilities as nurses, not on their credentials.

  3. Avatar
    Jo Volkening RN April 2, 2017 at 12:02 am - Reply

    All specialists who work in Illinois schools are certified, including school psychologists, school social workers, and school counselors. Not just any psychologist works in the school doing school psychology and it should be the same for school nurses. It goes so far beyond bandaids, booboos and asthma inhalers.
    All teachers and all staff must have a bachelor’s degree at a minimum (except school nurses?)! School nursing is a board-certifiable specialty in its own right. You do not want an ED nurse helping you deliver your baby, you do not want an oncology nurse when you are having a heart attack, and you do not want anything other than a CERTIFIED school nurse when you are dealing with your child/student with learning disabilities, ADHD, autism and other chronic health conditions in the educational setting. A school nurse is not a nurse who happens to work in a school. A school nurse has received specialized education, often at the master’s level, pertinent to her area of practice.

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